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Variations in glomerular filtration rate are associated with subclinical atherosclerosis in healthy postmenopausal women

Lambrinoudaki, Irene MD, PhD1; Tourlakis, Dimitrios MD1; Armeni, Eleni MD, PhD1; Kaparos, Georgios PhD2; Rizos, Demetrios PhD2; Augoulea, Areti MD, MSc, PhD1; Alexandrou, Andreas MD, PhD1; Kreatsa, Maria MD, PhD1; Deligeoroglou, Efthymios MD, PhD1; Stamatelopoulos, Kimon MD, PhD3

doi: 10.1097/GME.0000000000000302
Original Articles
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Objective This study aims to evaluate the potential effects of renal function variations on vascular structure before the development of hypertension.

Methods This pilot study included 141 postmenopausal women without evidence of renal dysfunction or hypertension. Markers of renal function and levels of glomerular filtration rate (GFR)—using standard calculations (GFR based on levels of creatinine [GFRepi]) and newer creatinine and/or cystatin calculations (GFR based on levels of creatinine and cystatin [GFRcr cystatin] and GFR based on levels of cystatin [GFRcystatin])—were associated with hemodynamic parameters and markers of vascular structure (intima-media thickness [IMT] and presence of atheromatous plaques in carotid and femoral arteries).

Results Levels of GFRepi, GFRcr cystatin, and GFRcystatin exhibited a significant negative correlation with femoral artery IMT, whereas levels of GFRepi correlated significantly with mean carotid bulb (CB) IMT. Multivariate analysis showed that CB-IMT was predicted by GFRepi levels and age (β-coefficient = −0.212, P = 0.020), whereas femoral artery IMT was predicted by GFRepi levels (β-coefficient = −0.293, P = 0.001). GFRepi levels lower than the 25th percentile were associated with higher CB-IMT (P = 0.009), femoral artery IMT (P = 0.001), and combined IMT (P = 0.035) compared with higher GFRepi levels. Moreover, GFRepi levels greater than the 25th percentile were associated with lower odds for the presence of atherosclerotic plaques at the CB and carotid arteries combined (CB: odds ratio, 0.146; P = 0.006; combined: odds ratio, 0.249; P = 0.043) compared with lower GFRepi levels.

Conclusions A mild decrease in renal function within normal limits of GFR is independently associated with the presence of subclinical atherosclerosis in a sample of apparently healthy young postmenopausal women. Assessment of GFR using creatinine (vs cystatin C) levels is a more sensitive marker of its association with IMT and atherosclerotic plaques in this postmenopausal population.

From the 1Second Department of Obstetrics and Gynecology and 2Hormonal and Biochemical Laboratory, University of Athens, Aretaieio Hospital, Athens, Greece; and 3Department of Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece.

Received April 15, 2014; revised and accepted June 2, 2014.

Funding/support: This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Irene Lambrinoudaki, MD, PhD, 27, Themistokleous Street, Dionysos, Athens GR-14578, Greece. E-mail: ilambrinoudaki@aretaieio.uoa.gr

© 2015 by The North American Menopause Society.